Explore the vast range of titles available.

BACKGROUND:Arkansas and Iowa received waivers from the federal government in 2014 to use federal Medicaid expansion funding to enroll beneficiaries in commercial insurance plans on the Marketplaces. One key hypothesis of these “private option” or “premium assistance” programs was that Medicaid beneficiaries would experience increased access to care. In this study, we compare new patient primary care appointment availability and wait-times for beneficiaries of traditional Medicaid and premium assistance Medicaid. METHODS:Trained field staff posing as patients, randomized to traditional Medicaid or Marketplace plans, called primary care practices seeking new patient appointments in Arkansas and Iowa in May to July 2014. All calls were made to offices that previously indicated being in-network for the plan. Offices were drawn randomly, within insurance type, based on the county proportion of the population with each insurance type. We calculated appointment rates and wait-times for new patients for traditional Medicaid and Marketplace plans. RESULTS:In Arkansas, Marketplace appointment rates were 27.2 percentage points higher than traditional Medicaid appointment rates (83.2% compared with 55.5%, P<0.001), while in Iowa, Marketplace appointment rates were 12.0 percentage points higher (86.3% compared with 74.3%, P<0.001). Conditional on receiving an appointment, median wait-times were roughly 1 week in each state without significant differences by insurance type. CONCLUSIONS:The experiences of Arkansas and Iowa suggest that enrolling Medicaid beneficiaries into Marketplace plans may lead to higher primary care appointment availability for new patients at participating providers. Further research is needed on whether premium assistance programs affect quality and continuity of care, and at what cost.

We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of low-educated and low-income adults. We found that the Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured. There was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly. In terms of labor supply, estimates indicated that the Medicaid expansions had little effect on work effort despite the substantial changes in health insurance coverage. Most estimates suggested that the expansions increased work effort, although not significantly.

There has been broad variation among states in policy approaches to unwinding of continuous Medicaid coverage. But there is still time for policymakers and others to minimize the risk of coverage loss.

AbstractObjectiveTo estimate changes in healthcare spending in the US after implementation of the No Surprises Act (NSA) in 2022 among adults with direct purchase private insurance.DesignQuasi-experimental difference-in-differences study.Setting24 US states.ParticipantsAdults aged 19-64 years with direct purchase private insurance who participated in the Annual Social and Economic Supplement of the Current Population Survey 2019-24 and resided in states that gained NSA surprise billing protections (intervention states) or in states with comprehensive protections already in place (control states).Main outcome measuresInflation adjusted out-of-pocket spending, insurance premium spending, and high burden medical spending (defined as spending >10% of total family income on both out-of-pocket and premium costs).ResultsThe study population included 17 351 privately insured adults, with 8204 residing in the 18 intervention states and 9147 in the six control states. After implementation of the NSA, out-of-pocket spending showed a decline among privately insured adults in intervention states (from $3674 (£2776; €3214) to $2922, relative percentage change −16.5%, 95% confidence interval (CI) −27.9% to −3.2%), but not among privately insured adults in control states ($2704 to $2550, 1.9%, −11.6% to 17.4%). A significant differential reduction was observed in out-of-pocket spending among privately insured adults in intervention states compared with control states after the NSA (relative percentage change −18.0%, −30.2% to −3.7%; absolute change −$567, 95% CI −$1031 to −$102; P=0.02). In contrast, no differential changes were observed in premium spending (relative percentage change 1.9%, −13.9% to 20.7%; absolute change $93, −$737 to $924; P=0.82) and in high burden medical spending (absolute percentage point change −1.0%, 95% CI −5.2% to 3.1%, P=0.62) between the two groups. These findings were consistent across sociodemographic characteristics, including sex, race/ethnicity, poverty status, education level, and employment status.ConclusionsSubstantial declines occurred in out-of-pocket spending among direct purchase privately insured adults who gained NSA surprise billing protections. In contrast, premium spending and high burden medical spending did not change. Additional policy efforts are needed to reduce healthcare related financial strain in the US.

The Affordable Care Act (ACA) was signed into law 10 years ago. This first of two Health Policy Reports reviewing the challenges and successes of the law focuses on the provisions of the law that expanded coverage. The ACA has reduced the number of Americans who are uninsured and the out-of-pocket health care costs for those with low incomes.

The United States has seen a rapid increase in insurance coverage for health care services related to gender transition, driven by growing consensus on their medical necessity and new legal interpretations prohibiting insurance discrimination against transgender people. In tandem with the growing visibility and acceptance of transgender people in the United States, we have seen a rapid increase in insurance coverage for health care services related to gender transition. Despite ongoing court battles over federal nondiscrimination protections for transgender people and uncertainty over the future of the Affordable Care Act (ACA), this trend is likely to continue: Medicare, many state-regulated private plans, some state Medicaid programs, and an increasing number of employer-sponsored plans now cover transition-related care for transgender people. These changes are driven by a growing expert consensus on the medical necessity of gender transition, new . . .

Decisions by states about whether to expand Medicaid under the Affordable Care Act (ACA) have implications for hospitals' financial health. We hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. We tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance. We found that the ACA's Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion. Future congressional efforts to reform Medicaid policy should consider the strong relationship between Medicaid coverage levels and the financial viability of hospitals. Our results imply that reverting to pre-ACA eligibility levels would lead to particularly large increases in rural hospital closures. Such closures could lead to reduced access to care and a loss of highly skilled jobs, which could have detrimental impacts on local economies.

Background Several states in the US have passed laws mandating coverage of colorectal cancer (CRC) screening tests by health insurance plans. The impact of these state mandates on the use of colorectal cancer screening has not been evaluated among an age-eligible target population with access to care (i.e., health care insurance coverage). Methods We collected information on state mandates implemented by December 31, 2008 and used data on insured adults aged 50 and 64 years from the Behavioral Risk Factor Surveillance System between 2002 and 2008 to classify individual-level exposure to state mandates for at least 1 year. Multivariate logistic regression models (with state- and year- fixed effects, and patient demographic and socioeconomic characteristics) were used to estimate the effect of state mandates on recent endoscopy screening (either flexible sigmoidoscopy or colonoscopy during the past year). Results From 1999-2008, twenty-two states in the US, including the District of Columbia passed comprehensive laws requiring health insurance coverage of CRC screening including endoscopy tests. Residence in states with CRC screening coverage mandates in place for at least 1 year was associated with a 1.4 percentage point increase in the probability of utilization of recent endoscopy (i.e., 17.5% screening rates in those with mandates versus 16.1% in those without, Adjusted OR = 1.10, 95% CI: 1.02 - 1.20, p = 0.02). Conclusions The findings suggest a positive, albeit small, impact of state mandates on the use of recent CRC screening endoscopy among the target eligible population with health insurance. However, more research is needed to evaluate potential effects of mandates across health insurance types while including controls for other system-level factors (e.g. endoscopy and primary care capacity). National health insurance reform should strive towards a system that expands access to recommended CRC screening tests.

The Patient Protection and Affordable Care Act (ACA) will expand coverage of mental health and substance use disorder benefits and federal parity protections to over 60 million Americans. The key to this expansion is the essential health benefit provision in the ACA that requires coverage of mental health and substance use disorder services at parity with general medical benefits. Other ACA provisions that should improve access to treatment include requirements on network adequacy, dependent coverage up to age 26, preventive services, and prohibitions on annual and lifetime limits and preexisting exclusions. The ACA offers states flexibility in expanding Medicaid (primarily to childless adults, not generally eligible previously) to cover supportive services needed by those with significant behavioral health conditions in addition to basic benefits at parity. Through these various new requirements, the ACA in conjunction with Mental Health Parity and Addiction Equity Act (MHPAEA) will expand coverage of behavioral health care by historic proportions.

Insurance coverage for prenatal care, labor and delivery care, and postpartum care for undocumented immigrants consists of a patchwork of state and federal policies, which varies widely by state. According to federal law, states must provide coverage for labor and delivery through Emergency Medicaid. Various states have additional prenatal and postpartum coverage for undocumented immigrants through policy mechanisms such as the Children’s Health Insurance Program’s “unborn child” option, expansion of Medicaid, and independent state-level mechanisms. Using a search of state Medicaid and federal government websites, we found that 27 states and the District of Columbia provide additional coverage for prenatal care, postpartum care, or both, while 23 states do not. Twelve states include any postpartum coverage; 7 provide coverage for 12 months postpartum. Although information regarding coverage is available publicly online, there exist many barriers to access, such as lack of transparency, lack of availability of information in multiple languages, and incorrect information. More inclusive and easily accessible policies are needed as the first step toward improving maternal health among undocumented immigrants, a population trapped in a complicated web of immigration policy and a maternal health crisis. ( Am J Public Health. 2024;114(10):1051–1060. https://doi.org/10.2105/AJPH.2024.307750 )